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Friday, 28 November 2014

In this month's blog post, Dr Ida Milne, Irish Research Council ELEVATE fellow co-funded by Marie Curie Actions, writes about her postdoctoral project on childhood illness in twentieth-century Ireland.

We live in an era where we expect our
children to survive to adulthood without having their lives threatened by
common infectious diseases of childhood.
The situation was rather different in the Ireland of the early part of
the twentieth century. In 1911, more than 2,000 infants under the age of
two died from diarrhoeal illnesses, almost double the number that died the
previous year. The increase was not
helped by the hot summer, which exacerbated the hygiene difficulties in an era
when many houses, even of the affluent, did not have running water or flush
toilets. As a twenty first century mother, I find the idea of nursing a child
suffering from diarrhoea in an overcrowded third floor bathroomless tenement almost
unimaginable.

Child mortality in the early-twentieth century

Having healthy children who would survive
to adulthood was not taken as the norm, as we do now. Statistics tabulated by
the Registrar-General in 1911 show that one-fifth of the total 72,475 deaths in 1911
were children under 5; of these, 945 were caused by ‘convulsions’ and 1,370 by
bronchitis. Scarlet fever claimed the lives of 260 children under fifteen; 460
under-fifteens died from measles, and 819 under tens from whooping cough.

Slums in Dublin, c.1865-1914 (Image from NLI collection: L_ROY_07881)

Dublin tenements, poverty, and childhood illness

Few
families, rich or poor, remained untouched by these deaths, but the over-crowded
living conditions of the poor could bring extremes of ill health. Stella Larkin
McConnon, trade unionist James Larkin’s granddaughter, told me that the poor health
of the nation’s children was one reason he became so interested in improving
living conditions for families. The
Larkins had good reason to be aware of the suffering. Stella’s own mother was brought up in
Marlborough Street in the heart of Dublin’s tenements, and was the only one of
ten children to survive to adulthood. Stella still remembers visiting the tenement,
one room with only one metal bed, the only toilet downstairs in another part of
the tenement, the cooking done on an open fire.

Improving child health

By 1981,
the landscape of death in childhood had changed radically. There were no deaths
in either Northern Ireland or the Republic from scarlet fever or whooping
cough, and only two from measles. Only
2.78 per cent of the total deaths, 916 of 32,929, were of children under five.

Many
factors contributed to the improvements over the course of the twentieth century: among them vaccination schemes
and more effective medicines, public health education and increased state
intervention in the health of children, better housing and diet and improved
air quality. It didn’t happen by accident – throughout the century, there were
individuals who identified areas to change and worked to effect that
change. Their number includes the first
chief medical officer for Dublin, Sir Charles Cameron, trade unionists like
James Larkin who worked to give families a decent wage, pioneering TB Dr
Dorothy Stopford Price, Department of
Local Government and Public Health Chief Medical Officer James Deeny, Noel
Browne and many others who played macro and micro roles in the significant
reduction in deaths from disease in childhood.

Research project on childhood disease

In October,
I began a three year Irish ResearchElevate Fellowship in the National University of Ireland and Queen’s
University, Belfast to research this dramatic changing landscape of childhood
disease, which is in general a good news
story for Irish society and Irish public health. While statistical and documentary sources
will be important to the project, a key feature will be a series of qualitative
interviews with medical professionals, with people who worked in relevant
Government and local authority roles, and with parents and sufferers. I intend
that these interviews should, at the conclusion of the project, be available in
an open access archive to other researchers.

Mother (to District Visitor): "Lumme, miss! There ain't no danger

of infection. Them children wet's got the measles is at the 'ead of

the bed, and them wet ain't is at the foot.

London Mail, 23 October 1913

Image courtesy of the Wellcome Library

The project
builds on and was partly inspired by the RAMI Living Medical History project;
Susan Mullaney, Mary O’Doherty andPatrick Plunkett of the RAMI section on history of medicine devised this
innovative project to interview retired medical doctors about their working
lives, collecting memories on the changes in medical practice over the course
of their careers. Several of the LMH interviewees had either suffered from
diseases like diphtheria and tuberculosis themselves, or had family who did,
and this really brought home to me how all-pervasive the effects of childhood
disease were on Irish society, that they were not merely confined to the poor
and the badly-housed, but could also invade better-off families.

Oral history of medical practitioners

Oral
history interviews can add flesh to the dry bones of statistics. When working
on my PhD on the effects of the 1918-19 influenza pandemic here, the people who spoke to me about suffering
this influenza as small children, or who told me about how their families coped
with the tragic losses of children or parents to the 1918-19 flu, breathed life
into its history, recreating the fear caused by the unpredictability of this most awesome of influenza pandemics.

In the case
of this new project, I am hoping to find people who can talk about the changing
landscape of childhood illness in the twentieth century, from their own perspective,
whether as medical workers, patients, parents or as Department of Health
officials and politicians.

I’m curious about issues like knowledge
transfer – how and what did parents learn about treating the illnesses their
children caught? As a child growing up
in the 1960s, I recall my mother hanging blankets over the windows when we
caught measles; the information she had been passed down by her mother was that
children with measles could damage their eyesight if they read or were in daylight.

When I had my own children in the 1990s, I was
struck by the efficiency and dedication of a district nurse in north Kildare
who made sure we parents brought our children for vaccinations, and cajoled and
informed those parents who had reservations about allowing their children to be
vaccinated. Getting medical workers like her to talk about their work is one of
the goals of this project. This district nurse was, it seems to me, a local
hero, a micro role player who was a small but significant cog in the expanding
machinery which managed and significantly improved the health of our children
over the course of the twentieth century.

Dr Ida Milne is a social historian based at NUI Maynooth and Queen's University Belfast. She holds an ELEVATE Irish Research Council International Career Development Fellowship co-funded by Marie Curie Actions.

Tuesday, 4 November 2014

In this month's blog post, Susan Grant reports on the recent 'Soviet healthcare in the comparative perspective' workshop which took place at UCD in May 2014.

Historians of Soviet and medical history
met in the UCD Humanities Institute May 29-30 to discuss Soviet healthcare in
comparative perspective. Generously supported by the Wellcome Trust, UCD Seed
Funding, and the Irish Research Council, this workshop represented an important
international gathering of scholars from Ireland, the UK, Canada, and the
United States. The inter-disciplinary
nature of the workshop meant that there was much debate and discussion among
participants (the programme is available on the CHOMI website here).

Nursing in the Soviet Union

The overall aim of the workshop was to analyse the
history of Soviet nursing and healthcare in comparative perspective, and to
critically examine issues such as professionalization, gender, and care. The
workshop mandate was to evaluate Soviet nursing relative to international
nursing and healthcare, and to explore how nursing in the Soviet Union
developed in relation to other medical professions. Participants were asked to
consider the development of Russian healthcare and to compare the Soviet
healthcare system to that of other countries.

Comparative aspects of Soviet healthcare

The
workshop was a great success, particularly in facilitating cross-disciplinary
discussion about the comparative aspects of Soviet healthcare. Panels focused
on three key aspects of Soviet healthcare: professionalization, gender and
care. The issue of care and the idea of the ‘virtue script’ (as conceptualised
and explained in the work of Prof. Sioban Nelson, University of Toronto)
fostered a particularly engaging dialogue about how nursing care is conceived
and understood. This fed into discussions of what constitutes a ‘good’ and
‘bad’ nurse, as well as patient perceptions of ‘good’ and ‘bad’ nurses.Nursing care, whether in the Soviet Union or
elsewhere, depends on a variety of factors and an individual’s experience of
nursing care. Studies of Soviet nursing are limited and probing expectations of
care from an international perspective proved very productive in thinking about
approaches to Soviet nursing and healthcare practices.

Panel on gender

Papers that focused on gender were particularly
helpful in illuminating the difficulties and challenges of dealing with source
material such as memoirs, interviews, etc. Prof. Dan Healey, Dr Laura Kelly,
and Prof. Christopher Burton shared their experiences of working with memoir
literature and the problems this can raise in terms of medical history. This
was very informative for everyone, and especially instructive in highlighting
the similar experiences of scholars who focus on different periods and
countries. Indeed, scholars of medical and nursing history, and also the
history of Russia, Ireland, Great Britain, etc., found that they had much in
common. Participants specialising in Soviet history were surprised to learn of
the liberal aspects of medicine in Ireland at the turn of the century.
Cross-disciplinary dialogue here proved fruitful and underlined points of
intersection and diversion between Russia and the West.

Transnational healthcare

The
comparative dimensions of international healthcare were underscored in the
panel featuring Prof. Susan Solomon, Prof. Paul Weindling, and Prof. Anne Marie
Rafferty. Papers here focused on the transnational aspects of healthcare, dealing
with Soviet cultural diplomacy in the 1920s, continental nurses in the UK 1933-1945, and nursing and decolonization
during the second colonial occupation of Malaya, 1946-1955.

Round table on professionalization

The
issue of professionalization was discussed in the opening and round table
discussions. Scholars of Russian history, including Prof. Donald Filtzer, Prof.
Benjamin Zajicek, and Dr Susan Grant presented their papers on
professionalisation and practice in Soviet healthcare history. Discussions about professionalization were elaborated
on in the roundtable session, with participants Prof. Susan Solomon, Prof.
Sioban Nelson, Prof. Dan Healey, and Prof. Anne Marie Rafferty contributing to
a lively debate. It was questioned whether or not theories of
professionalisation and histories of the professions are helpful as methods in
analyzing both healthcare history and the Soviet case. Findings here were
inconclusive, with some scholars acknowledging the merits of
professionalisation literature in their work on the Soviet Union or healthcare,
and others noting that they found this literature less useful.

The
workshop proved that healthcare history continues to be a vibrant field and one
that has much value when considering comparative international experiences. We
look forward to more discussion of these debates in the future.